Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2022

Open Access 01-12-2022 | Influenza | Research

System dynamic modelling of healthcare associated influenza -a tool for infection control

Authors: Martina Sansone, Paul Holmstrom, Stefan Hallberg, Rickard Nordén, Lars-Magnus Andersson, Johan Westin

Published in: BMC Health Services Research | Issue 1/2022

Login to get access

Abstract

Background

The transmission dynamics of influenza virus within healthcare settings are not fully understood. Capturing the interplay between host, viral and environmental factors is difficult using conventional research methods. Instead, system dynamic modelling may be used to illustrate the complex scenarios including non-linear relationships and multiple interactions which occur within hospitals during a seasonal influenza epidemic. We developed such a model intended as a support for health-care providers in identifying potentially effective control strategies to prevent influenza transmission.

Methods

By using computer simulation software, we constructed a system dynamic model to illustrate transmission dynamics within a large acute-care hospital. We used local real-world clinical and epidemiological data collected during the season 2016/17, as well as data from the national surveillance programs and relevant publications to form the basic structure of the model. Multiple stepwise simulations were performed to identify the relative effectiveness of various control strategies and to produce estimates of the accumulated number of healthcare-associated influenza cases per season.

Results

Scenarios regarding the number of patients exposed for influenza virus by shared room and the extent of antiviral prophylaxis and treatment were investigated in relation to estimations of influenza vaccine coverage, vaccine effectiveness and inflow of patients with influenza. In total, 680 simulations were performed, of which each one resulted in an estimated number per season. The most effective preventive measure identified by our model was administration of antiviral prophylaxis to exposed patients followed by reducing the number of patients receiving care in shared rooms.

Conclusions

This study presents an system dynamic model that can be used to capture the complex dynamics of in-hospital transmission of viral infections and identify potentially effective interventions to prevent healthcare-associated influenza infections. Our simulations identified antiviral prophylaxis as the most effective way to control in-hospital influenza transmission.
Appendix
Available only for authorised users
Literature
1.
2.
3.
Cassini A, Colzani E, Pini A, Mangen MJ, Plass D, McDonald SA, et al. Impact of infectious diseases on population health using incidence-based disability-adjusted life years (DALYs): results from the Burden of Communicable Diseases in Europe study, European Union and European Economic Area countries, 2009 to 2013. Euro Surveill. 2018;23(16).
4.
Salgado CD, Farr BM, Hall KK, Hayden FG. Influenza in the acute hospital setting. Lancet Infect Dis. 2002;2(3):145–55.PubMedCrossRef
5.
Jhung MA, D'Mello T, Perez A, Aragon D, Bennett NM, Cooper T, et al. Hospital-onset influenza hospitalizations--United States, 2010–2011. Am J Infect Control. 2014;42(1):7–11.PubMedCrossRef
6.
Cowling BJ, Ip DK, Fang VJ, Suntarattiwong P, Olsen SJ, Levy J, et al. Aerosol transmission is an important mode of influenza A virus spread. Nat Commun. 2013;4:1935.PubMedCrossRef
7.
Tellier R. Aerosol transmission of influenza A virus: a review of new studies. J R Soc Interface. 2009;6(Suppl 6):S783–90.PubMedPubMedCentral
8.
Vanhems P, Benet T, Munier-Marion E. Nosocomial influenza: encouraging insights and future challenges. Curr Opin Infect Dis. 2016;29(4):366–72.PubMedCrossRef
9.
Voirin N, Barret B, Metzger MH, Vanhems P. Hospital-acquired influenza: a synthesis using the Outbreak Reports and Intervention Studies of Nosocomial Infection (ORION) statement. J Hosp Infect. 2009;71(1):1–14.PubMedCrossRef
10.
Lee BY, Wong KF, Bartsch SM, Yilmaz SL, Avery TR, Brown ST, et al. The Regional Healthcare Ecosystem Analyst (RHEA): a simulation modeling tool to assist infectious disease control in a health system. J Am Med Inform Assoc. 2013;20(e1):e139–46.PubMedPubMedCentralCrossRef
11.
Sterman J Business Dynamics: McGraw-Hill; 2000.
12.
Davahli MR, Karwowski W, Taiar R. A System Dynamics Simulation Applied to Healthcare: A Systematic Review. Int J Environ Res Public Health. 2020;17(16).
13.
14.
Hirsch G, Homer J, Evans E, Zielinski A. A system dynamics model for planning cardiovascular disease interventions. Am J Public Health. 2010;100(4):616–22.PubMedPubMedCentralCrossRef
15.
Claeson M, Hallberg S, Holmstrom P, Wennberg AM, Gonzalez H, Paoli J. Modelling the Future: System Dynamics in the Cutaneous Malignant Melanoma Care Pathway. Acta Derm Venereol. 2016;96(2):181–5.PubMedCrossRef
16.
Yu Z, Deng M, Peng C, Song X, Chen Y, Zhang X, et al. A system dynamics modelling simulation based on a cohort of hepatitis B epidemic research in east China community. Epidemiol Infect. 2019;147:e86.PubMedPubMedCentralCrossRef
17.
Nguyen LKN, Megiddo I, Howick S. Simulation models for transmission of health care-associated infection: A systematic review. Am J Infect Control. 2020;48(7):810–21.PubMedCrossRef
18.
19.
Ferrer J, Boelle PY, Salomon J, Miliani K, L'Heriteau F, Astagneau P, et al. Management of nurse shortage and its impact on pathogen dissemination in the intensive care unit. Epidemics. 2014;9:62–9.PubMedCrossRef
20.
Sadsad R, Sintchenko V, McDonnell GD, Gilbert GL. Effectiveness of hospital-wide methicillin-resistant Staphylococcus aureus (MRSA) infection control policies differs by ward specialty. PLoS One. 2013;8(12):e83099.PubMedPubMedCentralCrossRef
21.
Kardas-Sloma L, Boelle PY, Opatowski L, Guillemot D, Temime L. Antibiotic reduction campaigns do not necessarily decrease bacterial resistance: the example of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2013;57(9):4410–6.PubMedPubMedCentralCrossRef
22.
Wang L, Ruan S. Modeling Nosocomial Infections of Methicillin-Resistant Staphylococcus aureus with Environment Contamination<sup/>. Sci Rep. 2017;7(1):580.PubMedPubMedCentralCrossRef
23.
van den Dool C, Bonten MJ, Hak E, Wallinga J. Modeling the effects of influenza vaccination of health care workers in hospital departments. Vaccine. 2009;27(44):6261–7.PubMedCrossRef
24.
van den Dool C, Bonten MJ, Hak E, Heijne JC, Wallinga J. The effects of influenza vaccination of health care workers in nursing homes: insights from a mathematical model. PLoS Med. 2008;5(10):e200.PubMedPubMedCentralCrossRef
25.
Blanco N, Eisenberg MC, Stillwell T, Foxman B. What Transmission Precautions Best Control Influenza Spread in a Hospital? Am J Epidemiol. 2016;183(11):1045–54.PubMedCrossRef
26.
Wendelboe AM, Grafe C, McCumber M, Anderson MP. Inducing Herd Immunity against Seasonal Influenza in Long-Term Care Facilities through Employee Vaccination Coverage: A Transmission Dynamics Model. Comput Math Methods Med. 2015;2015:178247.PubMedPubMedCentralCrossRef
27.
Morgan JS, Howick S, Belton V. A toolkit of designs for mixing Discrete Event Simulation and System Dynamics. Eur J Oper Res. 2017;257(3):907–18.CrossRef
28.
Gunal MM. A guide for building hospital simulation models. Health Syst. 2012;1(1):17–25.CrossRef
29.
Roberts SD, editor Tutorial on the simulation of healthcare systems2011: IEEE.
30.
Osgood N. Using Traditional and Agent-Based Toolsets for System Dynamics. Proceedings of the. International Conference of the System Dynamics Society; Boston. MA: The System Dynamics Society; 2007. p. 2007.
31.
Sansone M, Andersson M, Gustavsson L, Andersson LM, Norden R, Westin J. Extensive hospital in-ward clustering revealed by molecular characterization of influenza A virus infection. Clin Infect Dis. 2020.
32.
Chaves SS, Lynfield R, Lindegren ML, Bresee J, Finelli L. The US Influenza Hospitalization Surveillance Network. Emerg Infect Dis. 2015;21(9):1543–50.PubMedPubMedCentralCrossRef
33.
Lee N, Chan PK, Choi KW, Lui G, Wong B, Cockram CS, et al. Factors associated with early hospital discharge of adult influenza patients. Antivir Ther. 2007;12(4):501–8.PubMedCrossRef
34.
Lee N, Chan PK, Hui DS, Rainer TH, Wong E, Choi KW, et al. Viral loads and duration of viral shedding in adult patients hospitalized with influenza. J Infect Dis. 2009;200(4):492–500.PubMedCrossRef
35.
36.
Lau LL, Ip DK, Nishiura H, Fang VJ, Chan KH, Peiris JS, et al. Heterogeneity in viral shedding among individuals with medically attended influenza A virus infection. J Infect Dis. 2013;207(8):1281–5.PubMedPubMedCentralCrossRef
37.
Tsang TK, Cowling BJ, Fang VJ, Chan KH, Ip DK, Leung GM, et al. Influenza A Virus Shedding and Infectivity in Households. J Infect Dis. 2015;212(9):1420–8.PubMedPubMedCentralCrossRef
38.
Dobson J, Whitley RJ, Pocock S, Monto AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet. 2015;385(9979):1729–37.PubMedCrossRef
39.
Jefferson T, Jones MA, Doshi P, Del Mar CB, Hama R, Thompson MJ, et al. Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children. Cochrane Database Syst Rev. 2014;(4):CD008965.
40.
41.
Hergens MP, Baum U, Brytting M, Ikonen N, Haveri A, Wiman A, et al. Mid-season real-time estimates of seasonal influenza vaccine effectiveness in persons 65 years and older in register-based surveillance, Stockholm County, Sweden, and Finland, January 2017. Euro Surveill. 2017;22(8).
42.
Cowling BJ, Ip DKM, Fang VJ, Suntarattiwong P, Olsen SJ, Levy J, et al. Aerosol transmission is an important mode of influenza A virus spread. Nature. Communications. 2013;4.
43.
Huttunen R, Syrjanen J. Healthcare workers as vectors of infectious diseases. Eur J Clin Microbiol Infect Dis. 2014;33(9):1477–88.PubMedCrossRef
44.
Barlas Y. Formal aspects of model validity and validation in system dynamics System Dynamics Review. J Syst Dynamics Soc. 1996;12:3.
45.
Jefferson T, Jones MA, Doshi P, Del Mar CB, Hama R, Thompson MJ, et al. Neuraminidase inhibitors for preventing and treating influenza in adults and children. Cochrane Database Syst Rev. 2014;(4):CD008965.
46.
Sebille V, Chevret S, Valleron AJ. Modeling the spread of resistant nosocomial pathogens in an intensive-care unit. Infect Control Hosp Epidemiol. 1997;18(2):84–92.PubMedCrossRef
47.
Viana J, Brailsford SC, Harindra V, Harper PR. Combining discrete-event simulation and system dynamics in a healthcare setting: A composite model for Chlamydia infection. Eur J Oper Res. 2014;237(1):196–206.CrossRef
48.
Wong VW, Cowling BJ, Aiello AE. Hand hygiene and risk of influenza virus infections in the community: a systematic review and meta-analysis. Epidemiol Infect. 2014;142(5):922–32.PubMedCrossRef
49.
50.
Thomas RE, Jefferson T, Lasserson TJ. Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions. Cochrane Database Syst Rev. 2016;(6):CD005187.
51.
Okoli GN, Otete HE, Beck CR, Nguyen-Van-Tam JS. Use of neuraminidase inhibitors for rapid containment of influenza: a systematic review and meta-analysis of individual and household transmission studies. PLoS One. 2014;9(12):e113633.PubMedPubMedCentralCrossRef
52.
Hayden FG, Atmar RL, Schilling M, Johnson C, Poretz D, Paar D, et al. Use of the selective oral neuraminidase inhibitor oseltamivir to prevent influenza. N Engl J Med. 1999;341(18):1336–43.PubMedCrossRef
53.
Ye M, Jacobs A, Khan MN, Jaipaul J, Oda J, Johnson M, et al. Evaluation of the use of oseltamivir prophylaxis in the control of influenza outbreaks in long-term care facilities in Alberta, Canada: a retrospective provincial database analysis. BMJ Open. 2016;6(7):e011686.PubMedPubMedCentralCrossRef
54.
Peters PH Jr, Gravenstein S, Norwood P, De Bock V, Van Couter A, Gibbens M, et al. Long-term use of oseltamivir for the prophylaxis of influenza in a vaccinated frail older population. J Am Geriatr Soc. 2001;49(8):1025–31.PubMedCrossRef
55.
Munier-Marion E, Benet T, Regis C, Lina B, Morfin F, Vanhems P. Hospitalization in double-occupancy rooms and the risk of hospital-acquired influenza: a prospective cohort study. Clin Microbiol Infect. 2016;22(5):461 e7–9.CrossRef
56.
Uyeki TM, Bernstein HH, Bradley JS, Englund JA, File TM, Fry AM, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa. Clin Infect Dis. 2019;68(6):e1–e47.PubMedCrossRef
57.
Ip DKM, Lau LLH, Chan KH, Fang VJ, Leung GM, Peiris MJS, et al. The Dynamic Relationship Between Clinical Symptomatology and Viral Shedding in Naturally Acquired Seasonal and Pandemic Influenza Virus Infections. Clin Infect Dis. 2016;62(4):431–7.PubMed
58.
Fick J, Lindberg RH, Tysklind M, Haemig PD, Waldenstrom J, Wallensten A, et al. Antiviral oseltamivir is not removed or degraded in normal sewage water treatment: implications for development of resistance by influenza A virus. PLoS One. 2007;2(10):e986.PubMedPubMedCentralCrossRef
59.
Jarhult JD, Muradrasoli S, Wahlgren J, Soderstrom H, Orozovic G, Gunnarsson G, et al. Environmental levels of the antiviral oseltamivir induce development of resistance mutation H274Y in influenza A/H1N1 virus in mallards. PLoS One. 2011;6(9):e24742.PubMedPubMedCentralCrossRef
60.
Currie DJ, Smith C, Jagals P. The application of system dynamics modelling to environmental health decision-making and policy - a scoping review. BMC Public Health. 2018;18(1):402.PubMedPubMedCentralCrossRef
Metadata
Title
System dynamic modelling of healthcare associated influenza -a tool for infection control
Authors
Martina Sansone
Paul Holmstrom
Stefan Hallberg
Rickard Nordén
Lars-Magnus Andersson
Johan Westin
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
Influenza
Published in
BMC Health Services Research / Issue 1/2022
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-022-07959-7

Other articles of this Issue 1/2022

BMC Health Services Research 1/2022 Go to the issue

Research

Building integrated, adaptive and responsive healthcare systems – lessons from paramedicine in Ontario, Canada

Research

Pulse oximeter provision and training of non-physician anesthetists in Zambia: a qualitative study exploring perioperative care after training

Study protocol

Flourishing together: research protocol for developing methods to better include disabled people’s knowledge in health policy development

Research

Navigating uncertain illness trajectories for young children with serious infectious illness: a modified grounded theory study

Research

The impact of price transparency and competition on hospital costs: a research on all-payer claims databases

Research

Towards a liquid healthcare: primary care organisational and management strategies during the COVID-19 pandemic - a qualitative study